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Updated: Jul 12, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Stereotactic Radiosurgery Outcomes in Medically and Surgically Failed or Nonsurgical Candidates with Medically Failed
Karan J Yagnik1, Dana Erickson2, Irina Bancos2
1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, United States.
Abstract:
Objective Prolactinomas are treated with dopamine agonists (DAs) as first-line therapy and transsphenoidal surgery as an alternative approach for medically failed tumors. We sought to summarize the efficacy of stereotactic radiosurgery (SRS) in the medically and surgically failed prolactinomas as well as in nonsurgical candidates with medically failed prolactinomas by systematic review and meta-analysis. Method A literature search was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. Results A total of 11 articles (total N = 709) met inclusion criteria. Thirty-three percent of patients were able to achieve endocrine remission at a mean follow-up of 54.2 ± 42.2 months with no association between stopping DA and endocrine remission. Sixty-two percent of patients were able to achieve endocrine control with DA therapy and 34% of patients were able to decrease the dose of DA dose when compared with pre-SRS DA dose at the end of the follow-up period. However, 54% of patients required DA at the end of the follow-up to control hyperprolactinemia. Ninety percent of patients were able to achieve radiologic control at the end of the follow-up in comparison to pre-SRS imagings. Furthermore, 26% of patients newly developed hypopituitarism (one or more pituitary hormones) post-SRS throughout the follow-up period. Conclusion This systematic review and meta-analysis demonstrates SRS as an effective adjunct therapy in medically failed nonsurgical candidates or surgically and medically recalcitrant prolactinomas with a 33% chance of achieving endocrine remission, 62% of patients achieved hormonal control with DA and GKRS (gamma knife radio-surgery), with a 34% chance of decreasing DA dose and 90% chance of achieving radiologic control.
Insights
Stereotactic radiosurgery (SRS) offers an effective adjunct treatment for prolactinomas that resist medical or surgical therapies. This review found SRS can achieve endocrine remission in 33% of patients and radiologic control in 90%, with manageable side effects.
Area of Science:
- Neurosurgery
- Endocrinology
- Radiation Oncology
Background:
- Prolactinomas are typically managed with dopamine agonists (DAs) or surgery.
- Recalcitrant cases require alternative or adjunctive treatment strategies.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of stereotactic radiosurgery (SRS) for prolactinomas.
- To evaluate SRS in patients with medically or surgically failed tumors, and in nonsurgical candidates with medically failed disease.
Main Methods:
- A systematic literature search was performed adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.
- Meta-analysis of data from 11 included articles, encompassing 709 patients.
Main Results:
- Endocrine remission was achieved in 33% of patients at a mean follow-up of 54.2 months.
- Radiologic control was achieved in 90% of patients.
- New-onset hypopituitarism occurred in 26% of patients post-SRS.
Conclusions:
- Stereotactic radiosurgery is an effective adjunctive therapy for refractory prolactinomas.
- SRS offers a significant chance of endocrine remission and radiologic control, with a notable rate of patients reducing DA dosage.
